Uveitis-Glaucoma-Hyphema Plus Syndrome

To highlight the importance of imaging modalities in the diagnosis of uveitis-glaucoma-hyphema (UGH) plus syndrome caused by intraocular lens (IOL) complications.

A case report from Clinic of Ophthalmology, Medical Center of Postgraduate Education Prof. W. Orłowski Independent Public Clinical Hospital, Warsaw, Poland.

A 72-year-old woman presented with a one-year history of recurrent elevated intraocular pressure (IOP), anterior uveitis, hyphema and vitreous hemorrhage in the right eye (RE). She had been diagnosed with bilateral primary open-angle glaucoma (POAG) eight years earlier. She underwent cataract surgery in the RE two years earlier, with postoperative IOP reaching up to 32mmHg within the first two weeks. Cataract surgery in the left eye (LE) was also performed two years earlier, with implantation of a capsular tension ring due to lens subluxation. In both eyes, the IOLs were implanted in the capsular bag. Her medical history was significant for rheumatoid arthritis treated with oral methylprednisolone.

On clinical examination best corrected visual acuity was 0.9 in both eyes. IOP was 15 mmHg in the RE and 12mmHg in the LE. The cup-to-disc ratio in both eyes was 0.7. Apart from this, the anterior segment and fundus were unremarkable. The ultrasound biomicroscopy revealed iris-IOL chafing caused by one of the IOL’s haptics malpositioned in the sulcus. As the posterior capsule remained intact, repositioning of the IOL into the capsular bag was performed. No recurrence of UGH plus syndrome was observed after surgery.

In cases of anterior uveitis, elevated IOP and hyphema, UGH syndrome caused by IOL displacement should be considered. The presence of vitreous hemorrhage indicates UGH plus syndrome. The diagnosis was not straightforward because of concomitant comorbidities such as POAG and rheumatoid arthritis. In this case, the patient was treated pharmacologically for one year based on symptoms, whereas earlier use of ultrasound biomicroscopy could have led to prompt diagnosis and prevented prolonged treatment and potential complications.